May 21, 2010 -- In the chemotherapy infusion room at the Staten Island University Hospital sit several cancer patients hooked up to IVs. But they aren't leafing through magazines or staring at a talk show and worrying about their health.
Instead, their right legs are lifted up in the air, and they're circling their ankles clockwise while breathing deeply under the instruction of their yoga teacher.
"Most people don't look forward to chemotherapy," said Kerry Gillespie, director of the hospital's Center for Complementary Medicine. But he said the patients in this program look forward to the yoga class they take during their chemotherapy infusions every Thursday. Among other benefits, Gillespie said, "It gets their mind off the chemo."
Yoga is an ancient tradition involving meditation, deep breathing and movement through physical postures, and a growing body of literature suggests that it can be beneficial for multiple serious and chronic health conditions.
And now, new research released Thursday ahead of the American Society of Clinical Oncology meeting suggests yoga has beneficial effects on sleep quality, fatigue, and overall quality of life in cancer survivors.
Darlene Distler, 54, of Lafayette, N.Y., is a cancer survivor. She was just one of the participants in a University of Rochester study who said yoga helped her deal with the fatigue and insomnia she experienced from her treatment.
"I just loved it," she said. "This really, really helped. ... Several of us would fall asleep in class. It was that relaxing."
For Distler, the benefits were lasting. She said she still sometimes has problems with sleep, "but I will just do the breathing techniques when I wake up in the middle of the night, concentrate on my breathing, and it helps me get back to sleep. It's an empowering tool, something you can do that isn't harmful to your body."
Yoga May Help Cancer Patients With Treatment Side Effects
The new study, funded by the National Cancer Institute's Office of Cancer Complementary and Alternative Medicine, was carried out in nine different community sites around the country.
"To my knowledge, this is the largest clinical trial using yoga intervention in cancer survivors [to date]," said lead study author Karen Mustian, an exercise psychologist and physiologist at the University of Rochester.
Sleep disturbances and fatigue are an enormously burdensome problem among cancer survivors; 30 to 50 percent of newly diagnosed or recently treated cancer patients have trouble sleeping, and 70 to 96 percent of recently treated cancer patients complain of fatigue. The reasons for this aren't clear. Experts cite psychosocial factors as well as physical ones.
In the trial, 410 patients who had completed cancer therapy were split into two groups: one that participated in a four-week-long, twice-weekly yoga program, and one that did not.
Compared to how they felt beforehand, the survivors who participated in the yoga program afterward reported improvements in sleep quality and fatigue. Yoga participants also used less sleep medication than they did before the program, while non-yoga participants actually increased their use of sleep medication.
Mustian said patients were enthusiastic about the classes, and 86 percent attended more than half the sessions.
Experts not directly involved with the research called the study important.
"This trial will provide a solid contribution to the literature and provides good evidence that yoga may be an effective therapy to improve symptom control following a cancer diagnosis," said Lee W. Jones, an exercise physiologist at Duke University in Durham, N.C.
"This is groundbreaking," said Kathryn Schmitz of the University of Pennsylvania School of Medicine and author of soon-to-be-released guidelines on exercise in cancer survivors. Particularly exciting, Schmitz said, is the fact that this type of intervention can be applied in community settings based on oncologists' recommendations, rather than just in hospitals or academic centers.
"Cancer patients trust their oncologists," she said. "If they're going to be physically active, they need to know what they're going to do is okay with their oncologists, even after treatment."
Cancer Patients Seek Out Alternative Medicine
Complementary and alternative medicine (CAM) is widely sought by cancer patients and survivors, with a recent study estimating its use among 31 to 84 percent of pediatric cancer patients. In 2008, the National Cancer Institute supported approximately $121 million in CAM-related research.
Dr. Michael Irwin, professor of psychiatry and biobehavioral sciences at the UCLA David Geffen School of Medicine, is researching the use of tai chi in survivors. Like yoga, tai chi is a system with roots in Asia that incorporates stretching, gentle movements and the mind-body connection.
Irwin thinks tai chi and yoga may work by similar mechanisms.
"Yoga as well as tai chi both incorporate exercise," he said, "and some of the benefits may be through getting people up and moving around."
It's not entirely clear from a biological perspective why the yoga participants in this study saw improvements in their sleep problems and fatigue.
"If you break down the program into its basics -- breathing exercises, postures, mindfulness -- it's not entirely clear which component ... is most important," Mustian said. "It could be they all work together to improve sleep, fatigue and quality of life ... or it could be that one of them is really the most important piece."
Mustian recommended that cancer survivors interested in starting a yoga program to deal with sleep problems seek out gentle hatha yoga and restorative yoga classes. She also recommended seeking out instructors who have experience working with cancer survivors or other patients with chronic illnesses.
"There are some potential modifications they may want to make for survivors with certain physical limitations," she said.
Yoga Gives Cancer Patients Sense of Control
Distler said she would "absolutely" recommend the practice for cancer survivors with sleep problems.
"It's a tool we can take with us and use," she said. "It's great because you can do it anytime, and it has lots of positive benefits and no negative side effects."